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Self-Inflicted Cosmetic Tongue Split: A Case Report
•
Tim Bressmann, PhD •
A b s t r a c t
The objective of this case study was to obtain some first-hand information about the functional consequences of a
cosmetic tongue split operation for speech and tongue motility. One male patient who had performed the operation on himself was interviewed and underwent a tongue motility assessment, as well as an ultrasound examination. Tongue motility was mildly reduced as a result of tissue scarring. Speech was rated to be fully intelligible and
highly acceptable by 4 raters, although 2 raters noticed slight distortions of the sibilants /s/ and /z/. The 3-dimensional ultrasound demonstrated that the synergy of the 2 sides of the tongue was preserved. A notably deep posterior genioglossus furrow indicated compensation for the reduced length of the tongue blade. It is concluded that
the tongue split procedure did not significantly affect the participant’s speech intelligibility and tongue motility.
MeSH Key Words: self mutilation/complications; speech; tongue/injuries
© J Can Dent Assoc 2004; 70(3):156–7
This article has been peer reviewed.
C
osmetic “body modifications” include piercing of
the tongue, lips, face and genitals; deliberate scarring; “branding” with hot irons; the subcutaneous
implantation of studs; and the tongue split. The body
artists who perform these operations are medically
untrained. Both they and their clients regard body modifications as not very invasive or dangerous. However, there is
increasing evidence in the literature that tongue and lip
piercings may lead to tooth fractures,1,2 gingival recession,3,4 severe wound inflammation,5,6 allergic reactions,7
brain abcesses8 and endocarditis.9,10 The cosmetic tongue
split operation is a relatively recent fashion trend. In this
procedure, the anterior tongue blade is cut apart along the
midline and cauterized to prevent reattachment of the separated sides. So far, functional consequences of this operation have only been addressed in one previous publication:
Benecke11 describes the case of a young woman who
underwent a tongue split procedure along with a number of
other body modifications.
The author comments that speech and swallowing were
unaffected by the procedure, but this is only an impressionistic assessment. As body modifications seem to
become only more fashionable and popular, it is important
to gain knowledge about possible adverse effects of tongue
split operations on speech and tongue movement. In particular, dentists, oral surgeons and speech-language pathologists need to know if there is a new group of clients in the
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making. The purpose of this case study was to obtain firsthand information about the functional consequences of a
cosmetic tongue split operation for speech and tongue
motility.
Case Presentation
The participant was a 33-year-old man who works as a
self-employed body artist and specializes in facial and genital piercing, scarring, branding and jewellery implantation,
but has no formal medical training. The patient reported no
previous history of speech, language or hearing disorders.
He had performed the tongue split procedure on himself 2
years previous to the interview in his home during a social
get-together. The operation had been performed under a
light topical anesthetic with a surgical scalpel. He had cut
his tongue blade along the lingual midline and cauterized
the wound with a red-hot steel bead.
The participant reported that the wound healing and
swelling had been uncomplicated. On extreme tongue
protrusion and lateralization, he occasionally experienced
shooting pains in the left side of the tongue, due to an irritation of the lingual nerve. He had only noted speech problems during the acute healing phase. Following the tongue
split, the participant observed contraction and stiffening of
the scars and had tried to counteract this by stretching exercises. Despite these efforts, he estimated that the tongue
blade was now about 7 mm shorter in length than before
the operation.
Journal of the Canadian Dental Association
Self-Inflicted Cosmetic Tongue Split
Figure 1: View of the tongue split during
lingual elevation towards the prolabium.
Figure 2a: Midsagittal diagram of the
position of the tongue during the
production of ‘ng’. The dorsum of the
tongue is raised posteriorly towards the soft
palate. The tip of the tongue is retracted.
In a clinical assessment of tongue motility, the participant demonstrated sufficient lingual movement range. The
blade of the tongue appeared shortened, particularly in
lingual elevation towards the prolabium (Fig. 1). The
participant could not demonstrate independent antagonistic movement of the 2 sides of the tongue. Four speechlanguage pathologists with over 10 years of professional
experience reviewed a digitized 30-second sample of the
participant’s spontaneous speech, and assessed speech intelligibility and acceptability as a percentage. They also
commented on specific articulatory distortions. The mean
of the 4 intelligibility ratings was 99.25% (standard deviation [SD] = 1.5). The mean of the 4 ratings of speech
acceptability was 96.25% (SD = 4.79).
Two of the raters perceived slight distortions of the sibilants /s/ and /z/. To visualize the split tongue during speech
sounds, 3-dimensional ultrasound scans were made while
the participant sustained the sounds ‘sh’, ‘s’, ‘r’, ‘l’, ‘n’, and
‘ng’ (the velar nasal sound in the word “long”).
The ultrasound scans were made with a General Electric
Logiq 100 MP ultrasound machine (General Electric
Medical Systems, Milwaukee, Wis.), using a 6.5 MHz
endocavity ultrasound transducer E72 (General Electric
Medical Systems) and the 3D-Echotech Freescan software
(3D Echotec GmbH, Halbergmoos, Germany).
The ultrasound examination demonstrated that the
synergy of the 2 sides of the tongue was unaltered. The
midline scar could be visualized during retraction of the
tongue tip (Figs. 2a and 2b). A higher arching of the anterior dorsum of the tongue in alveolar sounds indicated a
compensatory increase in medial compression of the 2
disconnected sides of the tongue blade.
Conclusion
The tongue split operation has high risks for inflammation, dehiscence, infection and injury to supplying nerves
or arteries. It is certainly not to be recommended, particularly when it is done in a “do it yourself ” fashion, as is
Journal of the Canadian Dental Association
Figure 2b: Three-dimensional ultrasound
scan of dorsal elevation of the tongue
during sustained ‘ng’. The synergy of the 2
sides of the tongue is preserved. The midline
split of the tongue blade can be visualized
(indicated with a black line).
suggested on Web sites and in fanzine publications.
However, apart from the slight sibilant distortions and the
shortening of the tongue blade, the overall functional
outcome was surprisingly good in the presented case. C
Acknowledgement: This research was supported in part by a
Connaught New Staff Matching Grant from the University of
Toronto (grant number 419993).
Dr. Bressmann is assistant professor, graduate department of speech-language pathology, University of
Toronto, Toronto, Ontario.
Correspondence to: Dr. Tim Bressmann, Graduate
Department of Speech-Language Pathology, University
of Toronto, 500 University Avenue, Toronto ON M5G 1V7.
E-mail: [email protected].
The author has no declared financial interests.
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